Provider First Line Business Practice Location Address:
2734 N 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66104-5347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-655-5741
Provider Business Practice Location Address Fax Number:
816-655-5367
Provider Enumeration Date:
10/21/2008